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Objective: Our surgical results were reviewed to clarify the cause of glossopharyngeal neuralgia (GPN) and the effects of the microvascular decompression (MVD) procedure., Methods: Fourteen cases of idiopathic GPN were operated on through the transcondylar fossa (supracondylar transjugular tubercle) approach. Their clinical data and operative records were retrospectively reviewed., Results: In every case, vascular compression on the glossopharyngeal nerve was found and MVD was performed without any major complications. In 13 of the 14 cases the neuralgia completely disappeared postoperatively. Recurrence of pain was found in 1 case. Offending vessels were the posterior inferior cerebellar artery (PICA) in 10 cases, the anterior inferior cerebellar artery (AICA) in 2 cases, and both arteries in 2 cases. In 10 of the 14 cases, the high-origin PICA formed an upward loop between the glossopharyngeal and vagus nerves, compressing the glossopharyngeal nerve upward. In those cases, the PICA was transposed and fixed to the dura mater by the stitched sling retraction technique, and MVD was very effective., Conclusion: The offending artery was the PICA in most cases. MVD is expected to be very effective, especially when the radiological images show the following 3 findings: 1) high-origin PICA, 2) the PICA making an upward loop, and 3) the PICA coursing the supraolivary fossette. The transcondylar fossa approach is suitable for transposing the PICA by the stitched sling retraction technique, and provides sufficient surgical results.

Object: A possible relationship between neurovascular compression of the rostral ventrolateral medulla oblongata (RVLM) and essential hypertension is investigated using a specifically designed magnetic resonance (MR) imaging method. In conjunction with the ninth and 10th cranial nerves, baroreceptor afferents enter the RVLM, which represents a crucial relay for regulation of autonomic blood pressure. In 1985 Jannetta and coworkers proposed a causal relationship between essential hypertension and intraoperatively observed neurovascular compression of the left RVLM., Methods: Currently, MR imaging is the method of choice for the assessment of neurovascular relationships at the brainstem. By obtaining axial images of a thin-slice turbo inversion-recovery sequence and three-dimensional time-of-flight MR angiograms (fast imaging with steady-state precision), the authors documented the occurrence of neurovascular contacts with the RVLM at the level of the root entry zones (REZs) of the ninth and 10th cranial nerves in 25 patients with essential hypertension, 30 normotensive volunteers, and 10 patients with renal hypertension. Neurovascular contacts with the REZ at the left RVLM were found in 32% of patients with essential hypertension, 37% of normotensive volunteers, and 20% of patients with renal hypertension. In total, neurovascular contacts on either side of the RVLM were documented in 68% of patients with essential hypertension, 53% of normotensive volunteers, and 50% of patients with renal hypertension., Conclusions: The results do not support the theory of neurovascular compression in cases of essential hypertension. Findings of neurovascular contacts on MR images are not indications for decompression surgery. For further clarification, however, prospective MR imaging studies should be considered in young patients with essential hypertension in whom the history of high blood pressure is short.